Hospital Charges and Length of Stay Following Radical Cystectomy in the Enhanced Recovery After Surgery Era

Alice Semerjian, Niv Milbar, Max Kates, Michael A. Gorin, Hiten D. Patel, Heather J. Chalfin, Steven M. Frank, Christopher L. Wu, William W. Yang, Deb Hobson, Lindsay Robertson, Elizabeth Wick, Mark P. Schoenberg, Phillip M. Pierorazio, Michael H. Johnson, C. J. Stimson, Trinity J. Bivalacqua

Research output: Contribution to journalArticle

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Abstract

Objective: To report our center's experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. Materials and Methods: Our ERAS protocol was implemented for RC in December 2015. Outcomes in ERAS patients were compared with those in RC patients from the time period before ERAS. Patients were excluded if they underwent concomitant nephroureterectomy. Results: Fifty-six consecutive ERAS patients were compared with 54 pre-ERAS patients. The median charge for index hospitalization was $31,090 in the ERAS group and $35,489 in the pre-ERAS group (P = .036). The median LOS was 5.0 days in the ERAS group and 8.5 days in the pre-ERAS group (P = < .001). The pre-ERAS group had a significantly increased use of nasogastric tube (13.8% vs 30.0%) and parenteral nutrition (6.9% vs 20.4%). The overall complication rate (including infectious, renal, deep vein thrombosis and pulmonary embolism, myocardial infarction and stroke, and respiratory and gastrointestinal-related complications) was similar between the 2 groups (51.7% in the ERAS group and 62.0% in the pre-ERAS group, P = .28). Thirty- and 90-day readmissions also remained similar (19.0% vs 14.8%, P = .55, and 31.0% vs 27.7%, P = .64). The most common readmission reason was infection, specifically urinary tract infection. Conclusion: Implementation of the ERAS pathway at our center resulted in significantly reduced LOS and total hospital charge, with comparable rates of complication and readmission, highlighting the need for ERAS pathways in patients undergoing RC.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Jan 1 2017

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Hospital Charges
Cystectomy
Length of Stay
Renal Veins
Ileus
Parenteral Nutrition

ASJC Scopus subject areas

  • Urology

Cite this

Semerjian, A., Milbar, N., Kates, M., Gorin, M. A., Patel, H. D., Chalfin, H. J., ... Bivalacqua, T. J. (Accepted/In press). Hospital Charges and Length of Stay Following Radical Cystectomy in the Enhanced Recovery After Surgery Era. Urology. https://doi.org/10.1016/j.urology.2017.09.010

Hospital Charges and Length of Stay Following Radical Cystectomy in the Enhanced Recovery After Surgery Era. / Semerjian, Alice; Milbar, Niv; Kates, Max; Gorin, Michael A.; Patel, Hiten D.; Chalfin, Heather J.; Frank, Steven M.; Wu, Christopher L.; Yang, William W.; Hobson, Deb; Robertson, Lindsay; Wick, Elizabeth; Schoenberg, Mark P.; Pierorazio, Phillip M.; Johnson, Michael H.; Stimson, C. J.; Bivalacqua, Trinity J.

In: Urology, 01.01.2017.

Research output: Contribution to journalArticle

Semerjian, A, Milbar, N, Kates, M, Gorin, MA, Patel, HD, Chalfin, HJ, Frank, SM, Wu, CL, Yang, WW, Hobson, D, Robertson, L, Wick, E, Schoenberg, MP, Pierorazio, PM, Johnson, MH, Stimson, CJ & Bivalacqua, TJ 2017, 'Hospital Charges and Length of Stay Following Radical Cystectomy in the Enhanced Recovery After Surgery Era', Urology. https://doi.org/10.1016/j.urology.2017.09.010
Semerjian, Alice ; Milbar, Niv ; Kates, Max ; Gorin, Michael A. ; Patel, Hiten D. ; Chalfin, Heather J. ; Frank, Steven M. ; Wu, Christopher L. ; Yang, William W. ; Hobson, Deb ; Robertson, Lindsay ; Wick, Elizabeth ; Schoenberg, Mark P. ; Pierorazio, Phillip M. ; Johnson, Michael H. ; Stimson, C. J. ; Bivalacqua, Trinity J. / Hospital Charges and Length of Stay Following Radical Cystectomy in the Enhanced Recovery After Surgery Era. In: Urology. 2017.
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abstract = "Objective: To report our center's experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. Materials and Methods: Our ERAS protocol was implemented for RC in December 2015. Outcomes in ERAS patients were compared with those in RC patients from the time period before ERAS. Patients were excluded if they underwent concomitant nephroureterectomy. Results: Fifty-six consecutive ERAS patients were compared with 54 pre-ERAS patients. The median charge for index hospitalization was $31,090 in the ERAS group and $35,489 in the pre-ERAS group (P = .036). The median LOS was 5.0 days in the ERAS group and 8.5 days in the pre-ERAS group (P = < .001). The pre-ERAS group had a significantly increased use of nasogastric tube (13.8{\%} vs 30.0{\%}) and parenteral nutrition (6.9{\%} vs 20.4{\%}). The overall complication rate (including infectious, renal, deep vein thrombosis and pulmonary embolism, myocardial infarction and stroke, and respiratory and gastrointestinal-related complications) was similar between the 2 groups (51.7{\%} in the ERAS group and 62.0{\%} in the pre-ERAS group, P = .28). Thirty- and 90-day readmissions also remained similar (19.0{\%} vs 14.8{\%}, P = .55, and 31.0{\%} vs 27.7{\%}, P = .64). The most common readmission reason was infection, specifically urinary tract infection. Conclusion: Implementation of the ERAS pathway at our center resulted in significantly reduced LOS and total hospital charge, with comparable rates of complication and readmission, highlighting the need for ERAS pathways in patients undergoing RC.",
author = "Alice Semerjian and Niv Milbar and Max Kates and Gorin, {Michael A.} and Patel, {Hiten D.} and Chalfin, {Heather J.} and Frank, {Steven M.} and Wu, {Christopher L.} and Yang, {William W.} and Deb Hobson and Lindsay Robertson and Elizabeth Wick and Schoenberg, {Mark P.} and Pierorazio, {Phillip M.} and Johnson, {Michael H.} and Stimson, {C. J.} and Bivalacqua, {Trinity J.}",
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T1 - Hospital Charges and Length of Stay Following Radical Cystectomy in the Enhanced Recovery After Surgery Era

AU - Semerjian, Alice

AU - Milbar, Niv

AU - Kates, Max

AU - Gorin, Michael A.

AU - Patel, Hiten D.

AU - Chalfin, Heather J.

AU - Frank, Steven M.

AU - Wu, Christopher L.

AU - Yang, William W.

AU - Hobson, Deb

AU - Robertson, Lindsay

AU - Wick, Elizabeth

AU - Schoenberg, Mark P.

AU - Pierorazio, Phillip M.

AU - Johnson, Michael H.

AU - Stimson, C. J.

AU - Bivalacqua, Trinity J.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objective: To report our center's experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. Materials and Methods: Our ERAS protocol was implemented for RC in December 2015. Outcomes in ERAS patients were compared with those in RC patients from the time period before ERAS. Patients were excluded if they underwent concomitant nephroureterectomy. Results: Fifty-six consecutive ERAS patients were compared with 54 pre-ERAS patients. The median charge for index hospitalization was $31,090 in the ERAS group and $35,489 in the pre-ERAS group (P = .036). The median LOS was 5.0 days in the ERAS group and 8.5 days in the pre-ERAS group (P = < .001). The pre-ERAS group had a significantly increased use of nasogastric tube (13.8% vs 30.0%) and parenteral nutrition (6.9% vs 20.4%). The overall complication rate (including infectious, renal, deep vein thrombosis and pulmonary embolism, myocardial infarction and stroke, and respiratory and gastrointestinal-related complications) was similar between the 2 groups (51.7% in the ERAS group and 62.0% in the pre-ERAS group, P = .28). Thirty- and 90-day readmissions also remained similar (19.0% vs 14.8%, P = .55, and 31.0% vs 27.7%, P = .64). The most common readmission reason was infection, specifically urinary tract infection. Conclusion: Implementation of the ERAS pathway at our center resulted in significantly reduced LOS and total hospital charge, with comparable rates of complication and readmission, highlighting the need for ERAS pathways in patients undergoing RC.

AB - Objective: To report our center's experience with enhanced recovery after surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease the length of stay (LOS) and postoperative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns. Materials and Methods: Our ERAS protocol was implemented for RC in December 2015. Outcomes in ERAS patients were compared with those in RC patients from the time period before ERAS. Patients were excluded if they underwent concomitant nephroureterectomy. Results: Fifty-six consecutive ERAS patients were compared with 54 pre-ERAS patients. The median charge for index hospitalization was $31,090 in the ERAS group and $35,489 in the pre-ERAS group (P = .036). The median LOS was 5.0 days in the ERAS group and 8.5 days in the pre-ERAS group (P = < .001). The pre-ERAS group had a significantly increased use of nasogastric tube (13.8% vs 30.0%) and parenteral nutrition (6.9% vs 20.4%). The overall complication rate (including infectious, renal, deep vein thrombosis and pulmonary embolism, myocardial infarction and stroke, and respiratory and gastrointestinal-related complications) was similar between the 2 groups (51.7% in the ERAS group and 62.0% in the pre-ERAS group, P = .28). Thirty- and 90-day readmissions also remained similar (19.0% vs 14.8%, P = .55, and 31.0% vs 27.7%, P = .64). The most common readmission reason was infection, specifically urinary tract infection. Conclusion: Implementation of the ERAS pathway at our center resulted in significantly reduced LOS and total hospital charge, with comparable rates of complication and readmission, highlighting the need for ERAS pathways in patients undergoing RC.

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